Pharmacology · Class
Chemotherapy supportive agents !
Drugs that protect healthy tissue from chemotherapy or its side products: the bladder, the heart, the kidney or the bone marrow.
Updated 2026-11-01
What they are
A mixed group with one aim: make cancer treatment safer. Calcium folinate rescues normal cells from methotrexate (and boosts fluorouracil), mesna neutralises bladder-toxic metabolites of ifosfamide, dexrazoxane protects the heart from anthracyclines, rasburicase removes uric acid in tumour lysis, and amifostine protects the kidney and salivary glands.
Mechanism of action
Each one targets a specific mechanism of injury: a reduced folate that bypasses dihydrofolate reductase (calcium folinate); a thiol that binds acrolein in the urine (mesna); an iron chelator that limits anthracycline free radicals (dexrazoxane); an enzyme that oxidises uric acid to soluble allantoin (rasburicase); and a thiol compound that protects the kidney from cisplatin and the salivary glands from radiotherapy (amifostine).
Target: Several (folate pool, toxic metabolites, iron, uric acid)
Drugs in this class
- Calcium folinateAn already-reduced folate (leucovorin) that rescues normal cells from methotrexate and strengthens fluorouracil. Never…Reduced-folate pool (bypasses dihydrofolate reductase)
- MesnaA thiol drug that binds acrolein in the urine and protects the bladder from haemorrhagic cystitis caused by ifosfamide.Acrolein and other urotoxic ifosfamide metabolites (in urine)
- RasburicaseA recombinant urate oxidase enzyme that turns uric acid into soluble allantoin in tumour lysis. It must not be given…Uric acid (the drug is the enzyme urate oxidase)
- DexrazoxaneAn iron chelator that protects the heart from anthracyclines such as doxorubicin; it is also used for anthracycline…Topoisomerase II (catalytic inhibitor) and intracellular iron
- AmifostineA thiol cytoprotectant that protects the kidney from cisplatin and the salivary glands from radiotherapy. It has been…Normal tissue (thiol protection against cisplatin and radiation injury)
Others in the class
- calcium levofolinate
- glucarpidase
- palifermin
- uridine triacetate
Test yourself
Think of the answer, then tap the question to see it.
Which supportive drug neutralises acrolein, and which chemotherapy produces it?
Mesna; acrolein is a urinary metabolite of ifosfamide and cyclophosphamide.
Which enzyme deficiency must be ruled out before rasburicase?
Glucose-6-phosphate dehydrogenase (G6PD) deficiency.
Which drug protects the heart from doxorubicin, and how is it thought to work?
Dexrazoxane, an iron chelator that limits iron-driven free-radical injury.
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - LEUCOVORIN CALCIUM injection, powder, lyophilized, for solution (DailyMed (U.S. National Library of Medicine), 2026); DailyMed - MESNA injection, solution (DailyMed (U.S. National Library of Medicine), 2026); DailyMed - DEXRAZOXANE- dexrazoxane for injection injection, powder, lyophilized, for solution (DailyMed (U.S. National Library of Medicine), 2025); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 70 (McGraw Hill, 2023).
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Representative model, for educational purposes only.